Year 2010 temporary budget to make available the ... - Jersey City

C. 271 POLITICAL CONTRIBUTION DISCLOSURE FORM
Required Pursuant To N.lS.A. 19:44A-20.26
This form or its permitted facsimile must be submitted to the local unit
no .later than 10 days prior to the award of the contract.
furm. '
The undersigned being authorized to certify, hereby certifies that the submission provided herein represents
compliance with the provisions ofN.J.S.A. 19:44A-20.26 and as represented by the Instrctions accompanying this
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ignature ./ Printed Name Title
Part II - Contribution Disclosure
Disclosure requirement: Pursuant to N.l.S.A. 19:44A-20.26 this disclosure must include all reportable
political contrbutions (more than $300 per election cycle) over the 12 months prior to submission to the
commttees of the governent entities listed ori the form provided by the local unt.
0 Check here if disclosure is provided in electronic form.
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Contributor Name Recipient Name Date Dollar Amount
$
o Check here if
the inormation is continued on subsequent page(s)